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July 1, 2015Hospital PharmacyOpen Access

Reversal Strategies for Intracranial Hemorrhages in Patients Taking Oral Factor Xa Inhibitors

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Key result

Administration of fresh frozen plasma and 4-factor prothrombin complex concentrate provided minimal benefit in reversing coagulation abnormalities caused by factor Xa inhibitors in three patients with intracranial hemorrhage.

Why the study?

Do fresh frozen plasma and 4-factor prothrombin complex concentrate reverse coagulation abnormalities in patients with intracranial hemorrhage taking oral factor Xa inhibitors?

Population

3 patients with intracranial hemorrhage taking oral factor Xa inhibitors

Design

Case_series

Authors

BKBetsy KarliBBBillie BartelRPRachel Pavelko

Discussion

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Overview

Minimal reversal with FFP and 4F-PCC in factor Xa inhibitor ICH cases; hypothesis-generating and should not change practice without prospective data.

Study Design

Type

Case Report (n=3)

Structured PICO

Do fresh frozen plasma and 4-factor prothrombin complex concentrate reverse coagulation abnormalities in patients with intracranial hemorrhage taking oral factor Xa inhibitors?

P
Population
3 elderly men taking oral factor Xa inhibitors who presented with intracranial hemorrhage and were treated with fresh frozen plasma and/or 4-factor prothrombin complex concentrate.
I
Intervention
Fresh frozen plasma and 4-factor prothrombin complex concentrate
O
Outcome
Reversal of coagulation abnormalities and prevention of bleed progression

In life-threatening intracranial hemorrhage associated with factor Xa inhibitors, fresh frozen plasma and 4-factor prothrombin complex concentrate may offer minimal benefit but should be considered to prevent bleed progression.

Limitations

  • Small sample size of only 3 cases
  • Lack of a consistent treatment approach across cases
  • Difficult to determine relationship between intervention and outcome due to timing of last anticoagulant dose

Cite This Study

Karli et al. (2015) conducted a case report in Intracranial hemorrhage (n=3). Fresh frozen plasma and 4-factor prothrombin complex concentrate was evaluated on Reversal of coagulation abnormalities and hematoma expansion. Administration of fresh frozen plasma and 4-factor prothrombin complex concentrate provided minimal benefit in reversing coagulation abnormalities caused by factor Xa inhibitors in three patients with intracranial hemorrhage.

synapsesocial.com/papers/6a945c19a6e70f963a64ce80https://doi.org/10.1310/hpj5007-569
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